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General InformationVaccine Storage and Handling Best Practices 5

National Center for Immunization and Respiratory Disease

Vaccine Storage and Handling Guide

Selected BiologicalsDiphtheria Toxoid-, Tetanus Toxoid- and acellular Pertussis-Containing Vaccines DTaP: DAPTACEL, Infanrix, Tripedia DTaP-IPV: KINRIX DTaP-HepB-IPV: Pediarix DTaP-IPV/Hib: Pentacel Haemophilus influenzae type b-Containing Vaccines Hib: ActHIB, Hiberix, PedvaxHIB Hib-HepB: Comvax DTaP-IPV/Hib: Pentacel Hepatitis-Containing Vaccines HepA: Havrix, VAQTA HepB: Engerix-B, Recombivax HB HepA-HepB: Twinrix DTaP-HepB-IPV: Pediarix Hib-HepB: Comvax Human Papillomavirus Vaccines HPV2: Cervarix HPV4: Gardasil 23 23 19 19 19 11 15 15 15 11 11 11 11 11

Vaccine Storage and Handling Guide

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National Center for Immunization and Respiratory Disease

Vaccine Storage and Handling Guide

Influenza Vaccines LAIV: FluMist TIV: Afluria, Fluarix, FluLaval, Fluvirin, Fluzone, Fluzone High-Dose, Fluzone Intradermal Measles-, Mumps- and Rubella-Containing Vaccine MMR: M-M-RII MMRV: ProQuad Meningococcal Vaccines MCV4: Menactra, Menveo MPSV4: Menomune Pneumococcal Vaccines PCV13: Prevnar 13 PPSV23: Pneumovax 23 Poliovirus-Containing Vaccine IPV: IPOL DTaP-HepB-IPV: Pediarix DTaP-IPV: KINRIX DTaP-IPV/Hib: Pentacel Rotavirus Vaccines RV1: ROTARIX RV5: RotaTeq Tetanus Toxoid Vaccine TT: Tetanus Toxoid 57 53 53 49 11 11 11 45 45 37 41 33 69 29 27

Vaccine Storage and Handling Guide

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National Center for Immunization and Respiratory Disease

Vaccine Storage and Handling Guide

Tetanus Toxoid- and diphtheria toxoid-Containing Vaccines Td: DECAVAC DT: Diphtheria and Tetanus Toxoid Tetanus Toxoid-, diphtheria toxoid-, and acellular pertussis- Containing Vaccines Tdap: Adacel, Boostrix Varicella-Containing Vaccines VAR: Varivax (chickenpox) ZOS: Zostavax (herpes zoster/shingles) MMRV: ProQuad 69 69 69 65 61 61

ResourcesCDC Resources Other Resources State Immunization Program Information Manufacturer/Distributor Contact Information 74 75 76 77

Information contained in this document is based on the recommendations of the Advisory Committee on Immunization Practices (ACIP) and the manufacturers product information. A combination vaccine is defined as a product containing components that can be divided equally into independently available routine vaccines. A dash ( - ) between vaccine products indicates that products are supplied in their final form by the manufacturer and do not require mixing or reconstitution by the user. A slash ( / ) indicates that the products must be mixed or reconstituted by the user.

Vaccine Storage and Handling Guide

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General Information

Vaccine Storage and Handling Best PracticesVaccines must be stored properly from the time they are manufactured until they are administered. Immunization providers are responsible for proper storage and handling from the time vaccine arrives at the facility until the vaccine is given. Below is an outline of vaccine storage and handling best practices. CDCs Storage and Handling Toolkit contains detailed information on vaccine management. Immunization providers and staff are strongly encouraged to review the Storage and Handling Toolkit annually. Educate all staff, including temporary staff, as part of new staff orientation. In addition, Vaccines for Children (VFC) providers should follow VFC policy and work with their immunization program. Vaccine Management includes, but is not limited to, these three components. 1. The equipment used for vaccine storage and temperature monitoring is reliable and appropriate. 2. Staff is knowledgeable regarding proper vaccine storage and handling. At least 2 staff members should be responsible for vaccine management. 3. Written storage and handling plans are updated at least annually for: routine storage and handling of vaccines; and emergency vaccine retrieval and storage.

National Center for Immunization and Respiratory Disease

Vaccine Storage and Handling Guide

Routine Vaccine Storage and Handling Plan should include the following four elements.1. Ordering and Accepting Vaccine Deliveries Store vaccines at the recommended temperatures IMMEDIATELY upon arrival. Store refrigerated vaccines between 35F and 46F (2C and 8C). Store frozen vaccines between -58F and +5F (-50C and -15C). Ensure vaccines are delivered when the facility is open. Vaccine shipments should be delivered when staff is available to unpack and store the vaccine properly. Inform manufacturer/distributor when vaccine shipments can be delivered. VFC providers should also notify the immunization program. Consider holidays, vacations, changes in hours of operation, and staff schedules when ordering vaccines. Educate all facility staff about vaccine storage. Vaccine shipments are often accepted by nonmedical staff. They should be aware that vaccine needs to be stored according to the manufacturers guidelines immediately upon delivery.

Vaccine Storage and Handling Guide

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General Information

National Center for Immunization and Respiratory Disease

Vaccine Storage and Handling Guide

Order vaccines to maintain an adequate amount to meet the needs of the facilitys patients. The amount of vaccine needed can vary throughout the year. Anticipate peak periods such as back-to-school appointments or influenza season and order accordingly. Order the vaccines and presentations that are appropriate for the ages and types of patients the facility serves. Influenza vaccine, for example, is available from many manufacturers with differing indications. Maintain a vaccine inventory log including: 1. vaccine name and number of doses received; 2. date vaccine received; 3. condition of vaccine on arrival; 4. vaccine manufacturer and lot number; and 5. vaccine expiration date. 2. Storing and Handling Vaccines Store vaccines in refrigerator and freezer units which can maintain the appropriate temperature range and are large enough to maintain the years largest inventory without crowding. Stand alone units are preferred but household combination units with separate exterior doors and thermostats can be used. Dormitory-style refrigerators should not be used. A dormitory-style refrigerator is defined as a small combination freezer/refrigerator unit that is outfitted with one exterior door with an evaporator plate (cooling coil), which is usually located inside an icemaker compartment (freezer) within the refrigerator. Store vaccine in storage units designated specifically for biologics. If biologic specimens must be stored in the same unit, these should be stored on a lower shelf to prevent contamination. Food and drinks should never be stored in the same unit with vaccines. Keep a calibrated thermometer with a Certificate of Traceability and Calibration* in the refrigerator and freezer. These thermometers should be recalibrated as recommended by the manufacturer. Post Do Not Unplug signs next electrical outlets and Do Not Stop Power signs near circuit breakers to maintain a consistent power source. Read and document refrigerator and freezer temperatures at least twice each workday- in the morning and before the end of the workday. Keep temperature logs for at least 3 years.

*Certificate of Traceability and Calibration thermometer with calibration measurements traceable to a testing laboratory accredited by the International organization of Standardization, to the standards of the National Institute of Standards and Technology, or to another internationally recognized standards agency

Vaccine Storage and Handling Guide

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General Information

Store vaccine according to the manufacturers instructions. Aim to maintain storage unit temperatures within the middle of the acceptable temperature range. This allows for the small temperature fluctuations that can occur in refrigerators and freezers without exposing vaccines to unacceptable temperatures. Ensure good air circulation around the vaccine in the storage unit. Proper air circulation is essential to maintaining the correct storage temperatures. Bins, baskets, or some other type of uncovered containers that allow for air circulation should be used to store the vaccines. There should be space between the containers to promote air flow. Store vaccines on the shelves away from the walls, and vents in the part of the unit best able to maintain the required temperature. Vaccines should never be stored in the door of the freezer or refrigerator. The temperature here is not stable. Place frozen packs in the door of the freezer and water bottles in the door of the refrigerator to help the storage unit maintain a constant temperature. Frozen packs or water bottle should be placed securely so they do not dislodge and prevent the door from closing. In addition, caution must be taken to avoid weighing down the door so much that the seal is compromised when the door is closed. Store unopened and opened vaccines in their original box with the lid in place until administration. Several vaccines must be protected from light. This practice also helps to ensure different vaccines are not stored together in the same bins or containers which can lead to vaccine administration errors. And in the event of a power failure, studies have shown storing vaccines in the box helps to maintain the vaccine at the appropriate temperature. Prepare vaccines at the time the vaccine is administered. This includes reconstituting or mixing vaccine, if indicated. Use only the diluent supplied by the vaccine manufacturer. Store diluent according to the manufacturers instructions. 3. Managing Inventory Rotate stock so vaccine and diluent

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